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Minerva Gastroenterologica e Dietologica 2003 March;49(1):71-80

language: Italian

Surgical treatment of esophageal achalasia by Heller+Nissen laparoscopic procedure. A 24-hour ambulatory esophageal manometry study

Di Martino N., Izzo G., Monaco L., Sodano B., Torelli F., Del Genio A.


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Background. The aim of this work was to evaluate, by means of a 24-h esophageal manometry, the motor activity of esophageal body in achalasic patients before and after Heller's myotomy and Nissen's fundoplication.
Methods. Twenty-five achalasic patients un-derwent a 24-h esophageal manometry. After surgical treatment they had a further 24-h esophageal manometry during follow-up. Results. A statistically significant increase of amplitude of contraction and an increase, but not statistically significant, of frequency and duration of contractions were observed. The study of peristaltic activity showed an increase of peristaltic activity in total and complete sequences and decrease of dropped and interrupted peristaltic sequences.
Conclusions. These data surprisingly showed the presence of a peristaltic activity (31.2%), in achalasic esophageal body, and complete sequences in 20%. The improvement of peristaltic activity observed after surgical abolition of the functional sphincterial rub, proposes again the question about the fall of the peristaltic activity of the esophageal body, which could be due to the hard transit through the LES. This preliminary data seem to confirm, in qualitative and quantitative manner, the positive effect of Heller's myotomy and the null effect of Nissen's fundoplication on the esophageal transit.

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